Provider Demographics
NPI:1659950624
Name:SWEET, JERUSHAH ESTELLE
Entity Type:Individual
Prefix:
First Name:JERUSHAH
Middle Name:ESTELLE
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E GROVE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1816
Mailing Address - Country:US
Mailing Address - Phone:781-966-5770
Mailing Address - Fax:774-213-5479
Practice Address - Street 1:152 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3558
Practice Address - Country:US
Practice Address - Phone:800-804-5041
Practice Address - Fax:774-213-5479
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician